Rest and Sleep Nur 102 Rest calmness relaxation

Rest and Sleep Nur 102

• Rest: calmness, relaxation without emotional stress, freedom from anxiety • Sleep : altered state of consciousness in which the individual’s perception of and reaction to the environment are decreased • Characteristic of sleep: - Minimal physical activity - Variable level of consciousness - Change in body physiologic process - Decrease responsiveness to external stimuli

Functions of Sleep • Restores normal levels of activity • Restores normal balance among parts of the nervous system • Necessary for protein synthesis • Maintain Psychological well-being

Factors affecting Sleep • • • Illness Environment Fatigue Lifestyle Emotional stress Stimulants and alcohol Diet Smoking Motivation Medications

Common Sleep Disorders • Insomnia • Excessive daytime sleepiness • Parasomnias

Insomnia • • Difficulty falling asleep Waking up frequently Difficulty staying asleep Daytime sleepiness lead to: Difficulty concentrating Irritability Risk factors – Older age – Female

Excessive Daytime Sleepiness • • Hypersomnia Narcolepsy Sleep apnea Insufficient sleep

Hypersomnia • Sufficient sleep at night but cannot stay awake during day • Caused by medial and rarely due to psychological disorders • Can be caused by: CNS damage, liver, kidney problem, hypothyroidism

Narcolepsy • Caused by lack of hypocretin in CNS that regulates sleep • Clients have excessive day time sleepiness • Sleep at night usually begins with sleeponset REM period

Sleep Apnea • Frequent short breathing pauses during night • More than 5 apneic episodes > 10 sec/hr considered abnormal • Symptoms include snoring, frequent awakenings, difficulty falling asleep, morning headaches, memory and cognitive problems, irritability • Types include obstructive, central, mixed

Insufficient Sleep • Occur when a healthy person obtain less sleep than they need

Healthy Individuals Who Don’t Sleep • Experience sleepiness and fatigue during day • Attention and concentration deficits • Reduced vigilance • Distractibility • Reduced motivation • Fatigue, malaise, diplopia, dry mouth

Parasomnias • Is behavior that may occur during sleep or interfere with sleep • Classification (international): - Arousal disorders ( sleepwalking, sleep terrors) - Sleep wake transition disorders ( sleep talking) - Parasomnias associated with REM sleep ( nightmares) - Others (bruxism: clenching and grinding of the teeth)

Normal Sleep Requirements • Neonate (0 -3 mo) sleep 16 -18 hr’sday, irregular schedule with 1 -3 hr’s awake • Infant (3 mo-1 yrs) – 14 -15 hours/day, plus 2 naps, by 6 month infant start to sleep through the night • Toddler (1 -3 yrs) – 12 -14 hours/24 hrs including naps; night time mares are common • Preschooler (3 -5 yrs), 11 - 12 hours/night; it’s the good time to start sleep schedules

• School-age (5 -12 yrs) – 10 -11 hrs/night. • Adolescents (12 – 18 y) – typically get 7 1/2 hrs/night; need 9 -10 hr’s • Young adults – 7 -9 hrs/night • Middle adults – total time spent sleeping declines • Older adults – quality of sleep deteriorates; have increased awakenings, fragmentation, napping, earlier bed time and awake time, need 7 -9 hr’s

Nursing Process • • Assessment Sleep History: Usual sleep pattern Bedtime rituals performed to help the person fall asleep Use of sleep medication and other drugs Sleep environment Recent change in sleep pattern Medication history

• • Sleep diary: Total number of sleep hr’sday Activities performed 2 -3 hr’s before bedtime Bedtime rituals Time of going to bed, trying to fall asleep, waking up • Any thing pt believes have a +Ve or –Ve effect on sleep - PE( Enlarged Tonsils, septal deviation, darkness around eye, swelling in eye lid) - Diagnostic study (polysomnograph, EEG)

Nursing Diagnosis • • • Insomnia Disturbed sleep pattern Risk for injury RT sleepwalking Activity intolerance RT sleep deprivation Anxiety RT sleep apnea

Planning • Goal: to promote sleep maintain sleep pattern Objective: pt will be able to sleep 2 hr’s during my shift pt will be able to list 2 things he should do before went to sleep during my shift.

Implementation • Teach client the importance of sleep and rest in maintain active and productive lifestyles • Support bedtime rituals • Provide rest environment (soft light, calm, ventilated, comfort temp) • Instruct pt to wear loose fitting nightwear • Encourage pt to void before bed time • Offer back massage • Instruct pt to drink cup of warm milk before sleep • If pt have pain give analgesic 30 mint before sleep • Give medication if needed as hypnotics.

Implementation • • • Create a relaxing environment. Calm the mind. Ensure appropriate nutrition. Promote daytime activity and exercise. Manage stress. Initiate pharmacologic interventions. Promote sleep in the hospitalized client. Control environment Non-caffeinated bedtime snacks Comfortable room temperature Appropriate ventilation Appropriate lighting